Case Report
Dengue fever in patients under biologics

https://doi.org/10.1016/j.jcv.2014.08.011Get rights and content

Highlights

  • We survey patients under biotherapy for rheumatic conditions during dengue fever outbreaks.

  • Eight patients with dengue fever on biotherapy are described.

  • We do not observe severe forms of dengue fever in our patients.

Abstract

Dengue fever (DF) is an epidemic viral mosquito-borne infection limited to tropical and subtropical countries. Biological therapies have been frequently used for the last 15 years in the treatment of inflammatory rheumatic conditions like rheumatoid arthritis. However, no data is available regarding the characteristics of this infection in patients on biological therapy. Yet, numerous patients on biotherapy have holidays in countries where DF exists. Moreover, the mosquitoes Aedes albopictus, vector of this viral disease, is now found in some developed countries such as southern Europe and the USA, allowing the possibility of a DF outbreak. We conducted a survey of individuals on biotherapy and described a case series of the patients experiencing DF. Our 8 patients on biotherapy (anti-TNF, n = 6; rituximab, n = 2) for a rheumatic condition did not experience severe DF.

Section snippets

Why is this series important?

DF is an emerging mosquito-borne viral disease with over 50 million cases yearly in the world [1]. Worldwide there are 2.5 billion people living in developing countries who are at risk of DF. Biotherapies are monoclonal drugs or soluble receptor directly targeting cytokines (TNFα for etanercept and infliximab) or cells (B lymphocyte for rituximab) widely used in rheumatic diseases in countries which are currently not exposed to DF. Nevertheless their use in emerging countries, which are exposed

Cases description

From the aforementioned patients, nine were found, with a diagnosis of “confirmed” or “probable” DF as defined by the WHO [1]. Among these patients, none had haemorrhagic DF, 8 had confirmed DF and 1 had “probable DF” as defined by the WHO. The probable case was diagnosed on clinical signs in an epidemic context but with negative serology, so consequently this patient was removed from the analysis. Patient's characteristics are in Table 1.

Regarding DF, all patients had fever (low grade in two,

Other similar and contrasting cases in the literature

To our best knowledge, this is the first report of the occurrence of DF in patients taking biotherapies, antiCD20 or anti-TNFα.

Discussion

Patients on biotherapies are at increased risk of serious infections [3] either viral or bacterial, but no data has been published regarding DF. We didn’t see any severe cases of DF among our 293 patients on biotherapy (anti-TNF and anti-CD20) that experienced symptomatic DF. We believe, on account of the institutional survey, that we would not have forgotten the most severe cases, occurring in 1.6% according to the WHO. Whilst there is no human data regarding DF and individuals on biotherapy,

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

References (7)

There are more references available in the full text version of this article.

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